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# Rizatriptan ## Overview Rizatriptan is a selective serotonin 5-HT1B/1D receptor agonist used for the acute treatment of migraine headaches with or without aura. It exhibits rapid absorption and reaches peak plasma concentrations in approximately 1 to 1.5 hours. ## Primary Indications Acute treatment of migraine attacks in adults and pediatric patients (6–17 years). Not indicated for migraine prophylaxis or management of hemiplegic/basilar migraines. ## Adult Dosing * **Standard dose:** 5 mg or 10 mg orally. * **Administration:** If the migraine returns, a second dose may be taken after at least 2 hours. * **Maximum dose:** Do not exceed 30 mg in a 24-hour period. ## Pediatric Dosing (6–17 years) Dosing is weight-based. Use orally disintegrating tablets (ODT) or standard tablets: * **Weight < 40 kg:** 5 mg dose. * **Weight ≥ 40 kg:** 10 mg dose. * **Maximum dose:** Single dose only per 24-hour period. Safety of a second dose in pediatric populations has not been established. ## Dose Adjustments * **Renal/Hepatic Impairment:** No specific criteria, but exercise caution in severe hepatic impairment. * **Concurrent Propranolol:** Reduce dose to 5 mg (maximum 15 mg/24h) due to increased rizatriptan plasma concentrations. ## Contraindications * History of ischemic heart disease, coronary artery vasospasm (Prinzmetal’s angina), or MI. * History of stroke or transient ischemic attack (TIA). * Peripheral vascular disease or ischemic bowel disease. * Uncontrolled hypertension. * Concurrent use (or within 14 days) of Monoamine Oxidase Inhibitors (MAOIs). * Administration within 24 hours of another 5-HT1 agonist or ergotamine-type medication. ## Adverse Effects * **Common:** Dizziness, somnolence, paresthesia, fatigue, and dry mouth. * **Serious:** Coronary vasospasm, myocardial infarction, arrhythmias, and serotonin syndrome (especially when combined with SSRIs/SNRIs). ## Key Drug Interactions * **MAOIs:** Absolute contraindication; significantly increases rizatriptan levels. * **Propranolol:** Increases rizatriptan exposure; requires dose reduction. * **Serotonergic Drugs (SSRIs, SNRIs, TCAs):** Risk of serotonin syndrome. Monitor for agitation, autonomic instability, and neuromuscular abnormalities. * **Ergot-containing drugs:** Increased risk of prolonged vasospastic reactions. Avoid concomitant use. ## Monitoring * Monitor blood pressure during the first dose in patients with cardiovascular risk factors. * Observe for symptoms of serotonin syndrome if combined with other serotonergic agents. * Assess for chest, jaw, or neck tightness (typically non-cardiac, but must be ruled out if symptoms are severe or persistent). ## Clinical Pearls * **ODT Administration:** The ODT formulation should be placed on the tongue and allowed to dissolve; water is not required. Do not open the blister pack until ready for use. * **Medication Overuse Headache:** Frequent use (≥ 10 days/month) can lead to medication overuse headache; advise patients to limit use to the minimum frequency required. * **Efficacy:** Effectiveness is generally greater when taken as early as possible after the onset of the migraine. *** *Disclaimer: This information is for educational purposes and does not replace professional clinical judgment. Always verify current prescribing information, institutional protocols, and patient-specific contraindications via reliable pharmacopeia resources like Lexicomp or Micromedex before prescribing or administering medication.*